PCSS-O RFA - SAMHSA



Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Cooperative Agreement for a Provider’s Clinical Support System for the Appropriate Use of Opioids in the Treatment of Pain and Opioid–related Addiction

(Short Title: PCSS-Opioids)

(Initial Announcement)

Request for Applications (RFA) No. TI-14-009

Catalogue of Federal Domestic Assistance (CFDA) No. 93.243

Key Dates:

|Application Deadline |Applications are due by April 23, 2014. |

|Intergovernmental Review |Applicants must comply with E.O. 12372 if their state(s) participates. Review process |

|(E.O. 12372) |recommendations from the State Single Point of Contact (SPOC) are due no later than 60 days after |

| |application deadline. |

|Public Health System Impact Statement |Applicants must send the PHSIS to appropriate state and local health agencies by application |

|(PHSIS)/Single State Agency Coordination |deadline. Comments from Single State Agency are due no later than 60 days after application |

| |deadline. |

Table of Contents

EXECUTIVE SUMMARY: 4

I. FUNDING OPPORTUNITY DESCRIPTION 5

1. PURPOSE 5

2. EXPECTATIONS 6

II. AWARD INFORMATION 11

III. ELIGIBILITY INFORMATION 12

1. ELIGIBLE APPLICANTS 12

2. COST SHARING and MATCH REQUIREMENTS 12

3. OTHER 13

IV. APPLICATION AND SUBMISSION INFORMATION 13

1. CONTENT AND GRANT APPLICATION SUBMISSION 13

2. APPLICATION SUBMISSION REQUIREMENTS 16

3. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS 17

4. FUNDING LIMITATIONS/RESTRICTIONS 17

V. APPLICATION REVIEW INFORMATION 17

1. EVALUATION CRITERIA 17

2. REVIEW AND SELECTION PROCESS 22

VI. ADMINISTRATION INFORMATION 23

1. AWARD NOTICES 23

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS 23

3. REPORTING REQUIREMENTS 24

VII. AGENCY CONTACTS 25

Appendix A – Checklist for Formatting Requirements and Screen-out Criteria for SAMHSA Grant Applications 26

Appendix B – Guidance for Electronic Submission of Applications 28

Appendix C – Intergovernmental Review (E.O. 12372) Requirements 35

Appendix D – Funding Restrictions 37

Appendix E – Biographical Sketches and Job Descriptions 39

Appendix F – Sample Budget and Justification (no match required) 40

Appendix G – Background Information 50

Appendix H – Addressing Behavioral Health Disparities 51

EXECUTIVE SUMMARY:

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) is accepting applications for fiscal year (FY) 2014 Provider’s Clinical Support System for the Appropriate Use of Opioids in the Treatment of Pain and Opioid-related Addiction (Short Title: PCSS-Opioids) grant. The purpose of this grant is to develop a free national mentoring network that will provide clinical support (e.g., clinical updates, consultations, evidence-based outcomes, and training) to physicians, dentists, and other medical professionals in the appropriate use of opioids for the treatment of chronic pain and opioid-related addiction. This initiative will help SAMHSA address the nation’s major concern about the morbidity and mortality that have been caused by misuse/abuse and fatal drug interactions involving opioids used in the treatment of addiction and chronic pain.

|Funding Opportunity Title: |Cooperative Agreement for a Provider’s Clinical Support System for the |

| |Appropriate Use of Opioids in the Treatment of Pain and Opioid–related |

| |Addiction |

|Funding Opportunity Number: |TI-14-009 |

|Due Date for Applications: |April 23, 2014 |

|Anticipated Total Available Funding: |$1 million |

|Estimated Number of Awards: |Up to 1 |

|Estimated Award Amount: |Up to $1 million per year |

|Cost Sharing/Match Required: |No |

|Length of Project Period: |Up to 3 years |

|Eligible Applicants: |The American Society of Addiction Medicine, the American Academy of |

| |Addiction Psychiatry, the American Medical Association, the American |

| |Osteopathic Association, the American Psychiatric Association, and the |

| |American Dental Association. [See Section III-1 of this RFA for complete|

| |eligibility information.] |

I. FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) is accepting applications for fiscal year (FY) 2014 Provider’s Clinical Support System for the Appropriate Use of Opioids in the Treatment of Pain and Opioid-related Addiction (Short Title: PCSS-Opioids) grant. The purpose of this grant is to develop a free national mentoring network that will provide clinical support (e.g., clinical updates, consultations, evidence-based outcomes, and training) to physicians, dentists, and other medical professionals in the appropriate use of opioids for the treatment of chronic pain and opioid-related addiction. This initiative will help SAMHSA address the nation’s major concern about the morbidity and mortality that have been caused by misuse/abuse and fatal drug interactions involving opioids used in the treatment of addiction and chronic pain. (see Appendix G, Background Information).

SAMHSA has a strong interest in and responsibility for helping ensure that methadone, whether prescribed for pain management or dispensed for the treatment of opioid dependence, is being used appropriately by physicians who have been trained in the latest evidence-based practices. The population of focus for this initiative includes prescribers (physicians, dentists) and other health professionals working in SAMHSA-certified OTPs as well as those prescribers using opiate-based therapy for chronic pain.

The training and technical assistance provided under this initiative will address the specific complexities that are inherent in opioid-based therapy and the ways in which those complexities affect the appropriate care of individuals being treated for chronic pain and opioid-related addiction.

This program aims at reducing the likelihood of morbidity and mortality caused by substance misuse/abuse and fatal drug interactions involving opioids. PCSS-Opioids align with the goals of SAMHSA’s Prevention Strategic Initiative of reducing the likelihood of substance abuse, mental illness, and suicide across the Nation’s communities. The PCSS-Opioids program seeks to address behavioral health disparities among racial and ethnic minorities and LGBT populations by encouraging the implementation of training and technical assistance that assists recipients in decreasing the differences in access, use and outcomes among these subpopulations. (see Appendix H: Addressing Behavioral Health Disparities).

The PCSS-Opioids program is authorized under Section 509 of the Public Health Service Act, as amended. This announcement addresses Healthy People 2020 Substance Abuse Topic Area HP 2020-SA.

2. EXPECTATIONS

SAMHSA’s grants for training and technical assistance are intended to fund services or practices that have a demonstrated effectiveness in transferring knowledge and are appropriate for the specific technical assistance (TA) recipients of the grant program.

2.1 Required Activities

The PCSS-Opioids grant funds must be used primarily to support the following types of activities:

• Establish and maintain a cadre of expert clinicians and educators to provide support for qualified healthcare providers preparing for, or engaging in, opioid use in treatment of chronic pain and opioid-related addiction.

• Establish a steering committee to oversee the development of the PCSS-Opioids program for the treatment of opiate addiction and chronic pain and determine the direction of the project. The steering committee must be comprised of representatives from participating national professional medical organizations authorized by law to conduct trainings, other stakeholders, and the Government Project Officer (GPO). The purpose of the steering committee is to ensure the quality of educational content and the formulation of specific clinical topics for discussion and dissemination.

• Disseminate authoritative and standardized clinical materials and clinical tools.

• Promote PCSS-Opioids services to identified populations of focus, including subpopulations at risk for disparities in access, use, and outcomes of behavioral health treatment.

• Provide mentoring support, observation of practice, and consultative services by phone and e-mail that promote and support qualified healthcare providers in the use of opioids in the treatment of opioid-related addiction and chronic pain.

• Educate prospective practitioners through website (educational webinars) and published resources, such as Treatment Improvement Protocols (TIPS) containing science-based best practice guidelines for the treatment and maintenance of patients with opioid dependency and chronic pain.

• Use innovative technology transfer strategies to promote the adoption of culturally and linguistically appropriate, evidence-based and promising practices, and to disseminate relevant research findings in the areas of prevention and treatment for substance abuse disorders and chronic pain. Strategies must include, among other approaches, curricula and other learning events, delivered face-to-face and/or via the internet.

• Provide and maintain culturally and linguistically appropriate internet-based information and resources.

• Serve as a resource for community-based and faith-based organizations, recovery community groups, consumers and family members, and other stakeholders, including racial/ethnic or LGBT-specific organizations on recovery from substance use disorders, including medication-assisted treatment, and chronic pain issues.

• Enhance the clinical and cultural competencies of substance use disorders treatment and chronic pain practitioners, including capacity to deliver services in accordance with the National Standards for Culturally and Linguistically Appropriate Services in Health and Healthcare (National CLAS standards).

• Coordinate technical assistance efforts with local, state, and/or national organizations to help build knowledge and skills in substance abuse prevention/treatment and chronic pain services and capacity to address disparities in the access, use and outcomes of behavioral health treatment.

• Participate in cross-regional and/or network-wide activities to promote the adoption of evidence-based and promising practices, recovery-oriented systems of care, educational standards, and other topics of importance to the chronic and substance use disorders treatment/recovery field.

In addition, the grantee must synchronize its risk management activities with other initiatives. For example, the Food and Drug Administration (FDA) has evaluated a Risk Evaluation and Mitigation Strategy (REMS) for a subset of opioids – sustained release schedule II narcotic analgesics. Accordingly, there may be a need to focus this grant program on opioids not covered by the FDA Sustained Release Opioid REMS. For more information on REMS you can access the following website: .

2.2 Allowable Activities

• Develop and provide training and other resource materials pertaining to the safe prescribing of opioids for a variety of audiences (e.g., clinical supervisors, human resource managers, administrators and state/territory agency staff, front-line counseling staff, etc.).

• Develop, implement, and/or participate in activities aimed at upgrading standards of professional practice pertaining to the safe prescribing of opioids for providers of mental and substance use disorders prevention and treatment services, including working with academic institutions that train and educate students for these professions.

• Develop strategies and materials to enhance recruitment and retention of mental and substance use disorders treatment practitioners.

2.3 Other Expectations

Promotion of SAMHSA Products and Collaboration with SAMHSA

To maximize distribution of SAMHSA products, the grantee will be expected to promote and distribute SAMHSA publications related to the proposed topics of trainings and courses delivered by the grantee. In addition, the grantee will be required to provide periodic updates to SAMHSA’s Office of Communications, alerting SAMHSA of products and services, including training events that the grantee is making available.

If your application is funded, you will be expected to develop a health disparities impact statement.  This statement consists of three parts: (1) identify subpopulations vulnerable to disparities (e.g., racial, ethnic and sexual minority groups) and how they will be engaged in training and technical assistance activities (e.g., training, collaborations and partnerships, outreach, etc.); (2) propose a quality improvement plan to decrease the differences in access to, use and outcomes of these training and technical assistance activities among these subpopulations; and (3) the quality improvement plan should include an alignment  with the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care.  (See Appendix H: Addressing Behavioral Health Disparities.)

SAMHSA strongly encourages all grantees to provide a tobacco-free workplace and to promote abstinence from all tobacco products (except in regard to accepted tribal traditions and practices).

Over 2 million men and women have been deployed to serve in support of overseas contingency operations, including Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn.  Individuals returning from Iraq and Afghanistan are at increased risk for suffering post-traumatic stress and other related disorders.  Experts estimate that up to one-third of returning veterans will need mental health and/or substance abuse treatment and related services.  In addition, the family members of returning veterans have an increased need for related support services.  To address these concerns, SAMHSA strongly encourages all applicants to consider the unique needs of returning veterans and their families in developing their proposed project and consider prioritizing this population for services where appropriate.

2.4 Data Collection and Performance Measurement

All SAMHSA grantees are required to collect and report certain data so that SAMHSA can meet its obligations under the Government Performance and Results (GPRA) Modernization Act of 2010. You must document your ability to collect and report the required data in “Section D: Data Collection and Performance Measurement” of your application. Grantees will be required to report performance on the following performance measures:

• Number of consultation events, educational events, technical assistance events/contacts;

• Number of physicians, dentists, and other healthcare providers participating in each event;

• Percentage of physicians, dentists, and other healthcare providers satisfied with the educational and support services offered; and

• Percentage of healthcare providers who report that consultation or educational events resulted in appropriate practice change(s).

You must collect and report data using the CSAT Baseline Meeting Satisfaction Survey, along with the CSAT Follow-up Meeting Satisfaction Survey or the CSAT Baseline Training Satisfaction Survey with the CSAT Follow-up Training Satisfaction Survey. These survey instruments can be found at , along with instructions for completing these.

GPRA data must be collected at the end of each event and 30 days following the event. Once data are collected, the grantee is required to utilize the Services Accountability Improvement System (SAIS), CSAT’s web-based data collection and reporting tool, to enter data within 7 days after data are collected. Performance data will be reported to the public, the Office of Management and Budget (OMB), and Congress as part of SAMHSA’s budget request. Data collected by grantee will be used to demonstrate how SAMHSA’s grant programs are reducing behavioral health disparities nationwide.

Applicants should be aware that the SAIS reporting system will migrate to the Common Data Platform (CDP) during the life of the grant. 

2.5 Local Performance Assessment

Grantees must periodically review the performance data they report to SAMHSA (as required above) and assess their progress and use this information to improve management of their grant projects. The assessment should be designed to help you determine whether you are achieving the goals, objectives, and outcomes you intend to achieve and whether adjustments need to be made to your project. Performance assessments also should be used to determine whether your project is having/will have the intended impact on behavioral health disparities. You will be required to report on your progress achieved, barriers encountered, and efforts to overcome these barriers in a performance assessment report to be submitted at least annually.

At a minimum, your performance assessment should include the required performance measures identified above. You may also consider outcome and process questions, such as the following:

Outcome Questions:

• What was the effect of training and technical assistance on participants?

• What program/contextual/cultural/linguistic factors were associated with outcomes?

• What individual factors were associated with outcomes, including race/ethnicity/sexual orientation/gender identity?

• How durable were the effects?

Process Questions:

• How closely did implementation match the plan for delivery of training and technical assistance?

• What types of changes were made to the originally proposed plan?

• What led to the changes in the original plan?

• What types of changes were made to address behavioral health disparities, including the use of National CLAS Standards?

• What effect did the changes have on the planned training and technical assistance and performance assessment?

• Who provided (program staff) what services (modality, type, intensity, duration), to whom (individual characteristics), in what context (system, community), and at what cost (facilities, personnel, dollars)?

No more than 20 percent of the total grant award may be used for data collection, performance measurement, and performance assessment, e.g., activities required in Sections I-2.4 and 2.5 above.

2.6 Grantee Meetings

The grantee must plan to send a minimum of two people (including the Project Director) to at least one meeting with SAMHSA in each year of the grant. You must include a detailed budget and narrative for this travel in your budget. At these meetings, the grantee will present the results of its project, and federal staff will provide technical assistance. Each meeting will be no more than 1 day. These meetings are usually held in the Washington, D.C., area and attendance is mandatory

II. AWARD INFORMATION

Proposed budgets cannot exceed $1 million in total costs (direct and indirect) in any year of the proposed project. Annual continuation awards will depend on the availability of funds, grantee progress in meeting project goals and objectives, timely submission of required data and reports, and compliance with all terms and conditions of award.

This award will be made as a cooperative agreement.

Cooperative Agreement

This award is being made as a cooperative agreement because it requires substantial post-award federal programmatic participation in the conduct of the project. Under this cooperative agreement, the roles and responsibilities of the grantee and SAMHSA staff are:

Role of Grantee:

• Implement and assess the program in full cooperation with SAMHSA staff and contractors;

• Establish a steering committee to oversee the development of the PCSS-Opioids program for the treatment of opiate addiction and chronic pain and determine the direction of the project;

• Convene the steering committee, at a minimum yearly, and confer by conference call semiannually, to develop strategies to further enhance the project;

• Comply with all aspects of the terms and conditions of the cooperative agreement (to be issued with the award);

• Participate in selecting a chairperson for the steering committee;

• Provide required reports, including those related to GPRA; and

• Respond to requests by the GPO for information or data related to the program.

Role of SAMHSA Staff:

• Participate in the selection of physician and non-physician members of a steering committee that will develop the PCSS-Opioids project. The GPO will serve as a voting member of the steering committee, but will not chair the committee;

• Ensure that consultation services are provided to the states and regions of the country with the greatest need;

• Assist the grantee to meet quality improvement goals;

• Provide advice and assistance in developing the performance assessment;

• Foster learning, collaboration, and coordination with other SAMHSA-funded activities; and

• Provide some of the on-site educational activities, observation of practice, consultative services, peer monitoring, and other services envisioned under this program.

III. ELIGIBILITY INFORMATION

ELIGIBLE APPLICANTS

The purpose of this program is to provide clinical support to physicians, dentists, and other medical professionals in the appropriate use of opioids for the treatment of chronic pain and opioid-related addiction. SAMHSA is limiting eligibility for this cooperative agreement to the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Psychiatric Association, and the American Dental Association because these organizations have the greatest credibility/perceived authority to provide training, continuing education units (CEUs), and support services to their membership that other groups do not.  SAMHSA believes they are uniquely qualified to meet the requirements outlined in this announcement because they have the experience, infrastructure, and capacity in place to expeditiously begin program activities.

Any of these entities may apply individually; they may also apply as a consortium comprised of all or several of the eligible organizations. SAMHSA encourages applicants to apply as a consortium. If a consortium is formed for this purpose, a single organization in the consortium must be the legal applicant, the recipient of the award, and the entity legally responsible for satisfying the grant requirements. If a consortium submits an application, the application must include a written agreement outlining the roles and responsibilities of each organization participating in the consortium.

This agreement must be signed by an authorized official of each member of the consortium and included in the application as Attachment 3: Roles and Responsibilities of Participating Consortium Organizations.

The statutory authority for this program prohibits grants to for-profit agencies.

COST SHARING and MATCH REQUIREMENTS

Cost sharing/match is not required in this program.

OTHER

You must comply with the following three requirements, or your application will be screened out and will not be reviewed:

1. use of the SF-424 application form; Budget Information form SF-424A; Project/Performance Site Location(s) form; Disclosure of Lobbying Activities, if applicable; and Checklist.

2. application submission requirements in Section IV-2 of this document; and

3. formatting requirements provided in Appendix A of this document.

IV. APPLICATION AND SUBMISSION INFORMATION

CONTENT AND GRANT APPLICATION SUBMISSION

You must go to both () and the SAMHSA website () to download the required documents you will need to apply for a SAMHSA grant.



How to Download Forms from (see Appendix B for information on applying through )

To view and/or download the required application forms, you must first search for the appropriate funding announcement number (called the opportunity number).

On the site (), select the Apply for Grants option from the Applicants Tab at the top of the screen. Under STEP 1, click on the red button labeled: ‘Download a Grant Application Package’. Enter either the Funding Opportunity Number (SAMHSA’s Funding Announcement #) or the Catalogue of Federal Domestic Assistance (CFDA) Number exactly as they appear on the cover page of this RFA, then click the Download Package button. In the Instructions column, click the Download link.

You can view, print or save all of these forms. You can complete the forms for electronic submission to . Completed forms can also be saved and printed for your records. These required forms include:

• Application for Federal Assistance (SF-424);

• Budget Information – Non-Construction Programs (SF-424A);

• Project/Performance Site Location(s) Form;

• Disclosure of Lobbying Activities; and

• Checklist.

Applications that do not include these required forms will be screened out and will not be reviewed.

SAMHSA’s Grants Website

You will find additional materials you will need to complete your application on SAMHSA’s website (). These include:

• Request for Applications (RFA) – Provides a description of the program, specific information about the availability of funds, and instructions for completing the grant application. This document is the RFA;

• Assurances – Non-Construction Programs;

• Certifications; and

• Charitable Choice Form SMA 170.

Be sure to check the SAMHSA website periodically for any updates on this program.

1.1 Required Application Components

Applications must include the following 12 required application components:

• Application for Federal Assistance (SF-424) – This form must be completed by applicants for all SAMHSA grants. [Note: Applicants must provide a Dun and Bradstreet (DUNS) number to apply for a grant or cooperative agreement from the federal government. SAMHSA applicants are required to provide their DUNS number on the first page of the application. Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS number, access the Dun and Bradstreet website at or call 1-866-705-5711. To expedite the process, let Dun and Bradstreet know that you are a public/private nonprofit organization getting ready to submit a federal grant application. In addition, you must be registered in the new System for Award Management (SAM). The former Central Contractor Registration (CCR) transitioned to the SAM on July 30, 2012. SAM information must be updated at least every 12 months to remain active (for both grantees and sub-recipients). Once you update your record in SAM, it will take 48 to 72 hours to complete the validation processes. will reject submissions from applicants who are not registered in SAM or those with expired SAM registrations (Entity Registrations). The DUNS number you use on your application must be registered and active in the SAM. To Create a user account, Register/Update entity and/or Search Records from CCR, go to .]

• Abstract – Your total abstract must not be longer than 35 lines. It should include the project name, population(s) to be served (demographics and clinical characteristics), strategies/interventions, project goals and measurable objectives, including the number of people to be served annually and throughout the lifetime of the project, etc. In the first five lines or less of your abstract, write a summary of your project that can be used, if your project is funded, in publications, reports to Congress, or press releases.

• Table of Contents – Include page numbers for each of the major sections of your application and for each attachment.

• Budget Information Form – Use SF-424A. Fill out Sections B, C, and E of the SF-424A. A sample budget and justification is included in Appendix F of this document.

• Project Narrative and Supporting Documentation – The Project Narrative describes your project. It consists of Sections A through D. Sections A-D together may not be longer than 25 pages. (Remember that if your Project Narrative starts on page 5 and ends on page 30, it is 26 pages long, not 25 pages.) More detailed instructions for completing each section of the Project Narrative are provided in “Section V – Application Review Information” of this document.

The Supporting Documentation provides additional information necessary for the review of your application. This supporting documentation should be provided immediately following your Project Narrative in Sections E through F. There are no page limits for Section E but there are for Section F, Biographical Sketches/Job Descriptions. Additional instructions for completing these sections are included in Section V under “Supporting Documentation.” Supporting documentation should be submitted in black and white (no color).

• Attachments 1 through 3 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1 and 3 combined. There are no page limitations for Attachments 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc.

o Attachment 1: Letters of Commitment from any organization(s) participating in the proposed project.

o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2.

o Attachment 3: Roles and Responsibilities of Participating Consortium Organizations

• Project/Performance Site Location(s) Form – The purpose of this form is to collect location information on the site(s) where work funded under this grant announcement will be performed. This form will be posted on SAMHSA’s website with the RFA.

• Assurances – Non-Construction Programs. You must read the list of assurances provided on the SAMHSA website and check the box marked ‘I Agree’ before signing the face page (SF-424) of the application.

• Certifications – You must read the list of certifications provided on the SAMHSA website and check the box marked ‘I Agree’ before signing the face page (SF- 424) of the application.

• Disclosure of Lobbying Activities – Federal law prohibits the use of appropriated funds for publicity or propaganda purposes or for the preparation, distribution, or use of the information designed to support or defeat legislation pending before Congress or state legislatures. This includes “grass roots” lobbying, which consists of appeals to members of the public suggesting that they contact their elected representatives to indicate their support for or opposition to pending legislation or to urge those representatives to vote in a particular way. You must sign and submit this form, if applicable.

• Checklist – You must read the list of certifications provided on the SAMHSA website and check the box marked ‘I Agree’ before signing the first page (SF-424) of the application.

• Documentation of nonprofit status as required in the Checklist.

1.2 Application Formatting Requirements

Please refer to Appendix A, Checklist for Formatting Requirements and Screen-out Criteria for SAMHSA Grant Applications, for SAMHSA’s basic application formatting requirements. Applications that do not comply with these requirements will be screened out and will not be reviewed.

2. APPLICATION SUBMISSION REQUIREMENTS

Applications are due by 11:59 PM (Eastern Time) on April 23, 2014.

Your application must be submitted through . Please refer to Appendix B, “Guidance for Electronic Submission of Applications.”

3. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS

This grant program is covered under Executive Order (EO) 12372, as implemented through Department of Health and Human Services (DHHS) regulation at 45 CFR Part 100. Under this Order, states may design their own processes for reviewing and commenting on proposed federal assistance under covered programs. See Appendix C for additional information on these requirements as well as requirements for the Public Health Impact Statement.

4. FUNDING LIMITATIONS/RESTRICTIONS

Cost principles describing allowable and unallowable expenditures for federal grantees, including SAMHSA grantees, are provided in the following documents, which are available at :

• Educational Institutions: 2 CFR Part 220 and OMB Circular A-21

• State, Local and Indian Tribal Governments: 2 CFR Part 225 (OMB Circular A-87)

• Nonprofit Organizations: 2 CFR Part 230 (OMB Circular A-122)

• Hospitals: 45 CFR Part 74, Appendix E

In addition, SAMHSA’s PCSS-Opioid grant recipients must comply with the following funding restrictions:

• No more than 20 percent of the grant award may be used for data collection, performance measurement, and performance assessment expenses.

SAMHSA grantees also must comply with SAMHSA’s standard funding restrictions, which are included in Appendix D.

V. APPLICATION REVIEW INFORMATION

1. EVALUATION CRITERIA

The Project Narrative describes what you intend to do with your project and includes the Evaluation Criteria in Sections A-D below. Your application will be reviewed and scored according to the quality of your response to the requirements in Sections A-D.

• In developing the Project Narrative section of your application, use these instructions, which have been tailored to this program.

• The Project Narrative (Sections A-D) together may be no longer than 25 pages.

• You must use the four sections/headings listed below in developing your Project Narrative. You must place the required information in the correct section, or it will not be considered. Your application will be scored according to how well you address the requirements for each section of the Project Narrative.

• The Budget Justification and Supporting Documentation you provide in Sections E-F and Attachments 1-3 will be considered by reviewers in assessing your response, along with the material in the Project Narrative.

• The number of points after each heading is the maximum number of points a review committee may assign to that section of your Project Narrative. Although scoring weights are not assigned to individual bullets, each bullet is assessed in deriving the overall Section score.

Section A: Statement of Need (10 points)

• Discuss the current state of knowledge regarding culturally and linguistically competent services in treatment and prevention services for substance abuse disorders and opioid-based therapy for pain.

• Document the need for enhanced technical assistance to increase the capacity to implement and sustain effective substance abuse and chronic pain treatment services, including the need to address disparities in access, use, and outcomes of behavioral health services. Provide sufficient information on how the data was collected so reviewers can assess the reliability and validity of the data.

• Describe the service gaps, barriers, and other problems related to the need for technical assistance.

• Describe the stakeholders and resources that can help implement the needed technical assistance.

• Discuss how the proposed technical assistance will enhance the capacity of technical assistance recipients to improve access, appropriateness of services, and outcomes in diverse racial/ethnic and, if appropriate, LGBT populations.

Section B: Proposed Approach (35 points)

• Describe the purpose of the proposed project, including a clear statement of its goals and objectives. These must relate to the performance measures you identify in Section D, Data Collection and Performance Measurement.

• Describe the proposed project activities, how they meet the needs of the technical assistance recipients you propose to serve, and how they relate to your goals and objectives.

• Describe how the proposed activities will be implemented and how adherence to the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care will be monitored. For additional information go to: .

• Provide a chart or graph depicting a realistic time line for the entire project period showing key activities, milestones, and responsible staff. These key activities should include the requirements outlined in Section I-2: Expectations. [Note: The time line should be part of the Project Narrative. It should not be placed in an attachment.]

• Demonstrate familiarity with state-of-the-art strategies and practices in chronic pain and substance abuse treatment as well as technology transfer principles, strategies, and activities.

• Describe your plan for assisting SAMHSA-funded grantees with achieving goals for the Disparities Impact Strategy for their program.

• Clearly identify the total number of participants by race, ethnicity, and if appropriate, LGBT status you propose to serve annually, as well as the total number of events you plan to offer. In addition, provide a break-down of the:

o number of training events (i.e., short-term learning events designed primarily to raise awareness or impart limited information), as well as the number of participants who will be involved in training; and

o number of academic programming and technical assistance events (i.e., ongoing courses or learning interventions designed to develop or enhance skills, provide in-depth knowledge, or affect organizational processes related to the adoption of evidence-based or promising practices in agencies or systems), as well as the number of participants in academic programming and technical assistance events. [Note: For purposes of this program, academic programming and technical assistance are combined into a single service category.]

• Describe the membership, roles and functions, and frequency of meetings of the Steering Committee that is required for this program.

• Explain how you will develop and conduct training and technical assistance.

• Describe your collaborative relationships with the relevant organizations; provider associations; academic institutions; professional organizations; related systems of care; and others, including racial/ethnic-specific or LGBT organizations or how you plan to develop these relationships in order to formulate knowledge needs assessments and design technology transfer initiatives to respond to the needs of the recipients served. (Letters of Collaboration/Coordination should be included in Attachment 1.)

• Describe how you will promote the adoption of evidence-based/promising practices and state-of-the-art research in the areas of chronic pain and substance abuse therapies.

• Describe and give examples of how you will develop and revise innovative, research-based curricula and other products and materials as appropriate for the technical assistance recipients you will be serving.

• Describe how you will serve as a resource on chronic pain and substance abuse treatment issues to professional health organizations, community- and faith-based organizations, recovery community groups, consumers and family members, and other stakeholders, including racial/ethnic-specific or LGBT organizations.

• Discuss how the project plan will use culturally and linguistically appropriate approaches and methods, and address the following issues in technology transfer needs and opportunities:

o Demographics – race, ethnicity, religion, gender, age, geography, and socioeconomic status;

o Language and literacy;

o Sexual identity – sexual orientation and gender identity; and

o Disability.

• Describe any other organization(s) that will participate and their roles and responsibilities. Demonstrate their commitment to the project. Include letters of commitment from these organization(s) in Attachment 1 of your application.

• Discuss how you will promote SAMHSA’s products and publications and serve as a clearinghouse for the treatment of chronic pain and substance abuse disorders as well as prevention products and services.

• Describe the potential barriers to successful conduct of the proposed project and how you will overcome them.

• Describe how your activities will improve substance abuse and chronic pain prevention and treatment and address disparities in the access, use, and outcomes of behavioral healthcare.

Section C: Staff, Management, and Relevant Experience (25 points)

• Discuss the capability and experience of the applicant organization and other participating organizations with similar projects and populations, including experience providing culturally and linguistically appropriate, state-of-the-art, research-based training and technology transfer activities.

• Provide a complete list of staff positions for the project, including the Project Director and other key personnel, showing the role of each and their level of effort and qualifications.

• Discuss how key staff have demonstrated experience in serving the population to receive training/technical assistance and are familiar with and qualified to address the workforce development, cultural, and linguistic needs of this population.

• Describe the resources available for the proposed project (e.g., facilities, equipment).

Section D: Data Collection and Performance Measurement (30 points)

• Document your ability to collect and report on the required performance measures as specified in Section I-2.4 of this document. Describe your plan for data collection, management, analysis and reporting. Specify and justify any additional measures you plan to use for your grant project.

• Describe the data-driven quality improvement process by which sub-population disparities in access/use/outcomes will be tracked, assessed, and reduced.

• Describe how information related to process and outcomes will be routinely communicated to program staff and other stakeholders.

• Describe your plan for conducting the local performance assessment as specified in Section I-2.5 of this RFA and document your ability to conduct the assessment.

NOTE: Although the budget for the proposed project is not a scored review criterion, the Review Group will be asked to comment on the appropriateness of the budget after the merits of the application have been considered.

Budget Justification, Existing Resources, Other Support (other federal and non-federal sources)

You must provide a narrative justification of the items included in your proposed budget, as well as a description of existing resources and other support you expect to receive for the proposed project. Other support is defined as funds or resources, whether federal, non-federal or institutional, in direct support of activities through fellowships, gifts, prizes, in-kind contributions or non-federal means. (This should correspond to Item #18 on your SF-424, Estimated Funding.) Other sources of funds may be used for unallowable costs, e.g., meals, sporting events, entertainment.

Be sure to show that no more than 20 percent of the total grant award will be used for data collection, performance measurement, and local performance assessment. Specifically identify the items associated with these costs in your budget. An illustration of a budget and narrative justification is included in Appendix F, Sample Budget and Justification, of this document.

The budget justification and narrative must be submitted as file BNF when you submit your application into . (See Appendix B, Guidance for Electronic Submission of Applications.)

SUPPORTING DOCUMENTATION

Section E: Literature Citations

This section must contain complete citations, including titles and all authors, for any literature you cite in your application.

Section F: Biographical Sketches and Job Descriptions.

• Include position descriptions for the Project Director and all key personnel. Position descriptions should be no longer than 1 page each.

• For staff who have been identified, include a biographical sketch for the Project Director and other key positions. Each sketch should be 2 pages or less. Reviewers will not consider information past page 2.

• Information on what you should include in your biographical sketches and job descriptions can be found on in Appendix E of this document.

2. REVIEW AND SELECTION PROCESS

SAMHSA applications are peer-reviewed according to the evaluation criteria listed above.

Decisions to fund a grant are based on:

• the strengths and weaknesses of the application as identified by peer reviewers;

• when the individual award is over $150,000, approval by the Center for Substance Abuse Treatment’s National Advisory Council;

• availability of funds; and

• equitable distribution of awards in terms of geography (including urban, rural and remote settings) and balance among populations to receive training/technical assistance and program size.

VI. ADMINISTRATION INFORMATION

1. AWARD NOTICES

You will receive a letter from SAMHSA through postal mail that describes the general results of the review of your application, including the score that your application received.

If you are approved for funding, you will receive an additional notice through postal mail, the Notice of Award (NoA), signed by SAMHSA’s Grants Management Officer. The NoA is the sole obligating document that allows you to receive federal funding for work on the grant project.

If you are not funded, you will receive notification from SAMHSA.

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

• If your application is funded, you must comply with all terms and conditions of the grant award. SAMHSA’s standard terms and conditions are available on the SAMHSA website at .

• If your application is funded, you must also comply with the administrative requirements outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate. For more information see the SAMHSA website ().

• Depending on the nature of the specific funding opportunity and/or your proposed project as identified during review, SAMHSA may negotiate additional terms and conditions with you prior to grant award. These may include, for example:

o actions required to be in compliance with confidentiality and participant protection/human subjects requirements;

o requirements relating to additional data collection and reporting;

o requirements relating to participation in a cross-site evaluation;

o requirements to address problems identified in review of the application; or

o revised budget and narrative justification.

• If your application is funded, you will be held accountable for the information provided in the application relating to performance targets. SAMHSA program officials will consider your progress in meeting goals and objectives, as well as your failures and strategies for overcoming them, when making an annual recommendation to continue the grant and the amount of any continuation award. Failure to meet stated goals and objectives may result in suspension or termination of the grant award, or in reduction or withholding of continuation awards.

• If your application is funded, you must comply with Executive Order 13166, which requires that recipients of federal financial assistance provide meaningful access to limited English proficient (LEP) persons in their programs and activities. You may assess the extent to which language assistance services are necessary in your grant program by utilizing the HHS Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, available at .

• Grant funds cannot be used to supplant current funding of existing activities. “Supplant” is defined as replacing funding of a recipient’s existing program with funds from a federal grant.

3. REPORTING REQUIREMENTS

In addition to the data reporting requirements listed in Section I-2.4, grantees must comply with the reporting requirements listed on the SAMHSA website at .

3.1 Publications

Grantees are required to notify the Government Project Officer (GPO) and SAMHSA’s Publications Clearance Officer (240-276-2130) of any materials based on the SAMHSA-funded grant project that are accepted for publication.

In addition, SAMHSA requests that grantees:

• Provide the GPO and SAMHSA Publications Clearance Officer with advance copies of publications.

• Include acknowledgment of the SAMHSA grant program as the source of funding for the project.

• Include a disclaimer stating that the views and opinions contained in the publication do not necessarily reflect those of SAMHSA or the U.S. Department of Health and Human Services, and should not be construed as such.

SAMHSA reserves the right to issue a press release about any publication deemed by SAMHSA to contain information of program or policy significance to the substance abuse treatment/substance abuse prevention/mental health services community.

VII. AGENCY CONTACTS

For questions about program issues contact:

Anthony Campbell, RPH, D.O.

Project Officer

Division of Pharmacologic Therapies

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 7-1019

Rockville, Maryland 20857

(240) 276-2702

Tony.campbell@samhsa.

For Questions on grants management and budget issues contract:

Eileen Bermudez

Office of Financial Resources, Division of Grants Management

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 7-1091

Rockville, Maryland 20857

(240) 276-1412

eileen.bermudez@samhsa.

Appendix A – Checklist for Formatting Requirements and Screen-out Criteria for SAMHSA Grant Applications

SAMHSA’s goal is to review all applications submitted for grant funding. However, this goal must be balanced against SAMHSA’s obligation to ensure equitable treatment of applications. For this reason, SAMHSA has established certain formatting requirements for its applications. If you do not adhere to these requirements, your application will be screened out and returned to you without review.

• Use the SF-424 Application form; Budget Information form SF-424A; Project/Performance Site Location(s) form; Disclosure of Lobbying Activities, if applicable; and Checklist.

• Applications must be received by the application due date and time, as detailed in Section IV-2 of this grant announcement.

• You must be registered in the System Award Management (SAM) prior to submitting your application. The DUNS number used on your application must be registered and active in the SAM prior to submitting your application.

• Information provided must be sufficient for review.

• Text must be legible. Pages must be typed in black, single-spaced, using a font of Times New Roman 12, with all margins (left, right, top, bottom) at least one inch each. You may use Times New Roman 10 only for charts or tables. (See additional requirements in Appendix B, “Guidance for Electronic Submission of Applications.”)

• To ensure equity among applications, page limits for the Project Narrative cannot be exceeded.

To facilitate review of your application, follow these additional guidelines. Failure to adhere to the following guidelines will not, in itself, result in your application being screened out and returned without review. However, the information provided in your application must be sufficient for review. Following these guidelines will help ensure your application is complete, and will help reviewers to consider your application.

• Applications should comply with the following requirements:

o Budgetary limitations as specified in Sections I, II, and IV-4 of this announcement.

o Documentation of nonprofit status as required in the Checklist.

• Black print should be used throughout your application, including charts and graphs (no color). Materials with printing on both sides will be excluded from the application and not sent to peer reviewers.

• Pages should be numbered consecutively from beginning to end so that information can be located easily during review of the application. The abstract page should be page 1, the table of contents should be page 2, etc. The four pages of SF-424 are not to be numbered. Attachments should be labeled and separated from the Project Narrative and budget section, and the pages should be numbered to continue the sequence.

• The page limits for Attachments stated in Section IV-1.1 of this announcement should not be exceeded.

Appendix B – Guidance for Electronic Submission of Applications

SAMHSA discretionary grant applications must be submitted electronically through . SAMHSA will not accept paper applications, except when a waiver of this requirement is approved by SAMHSA. The process for applying for a waiver is described later in this appendix.

If this is the first time you have submitted an application through , you must complete three separate registration processes before you can submit your application. Allow at least two weeks (10 business days) for these registration processes, prior to submitting your application. The processes are:

1. DUNS Number registration:

The DUNS number you use on your application must be registered and active in the SAM.

2. System for Award Management (SAM) registration:

The System for Award Management (SAM) is a federal government owned and operated free website that replaces capabilities of the former Central Contractor Registry (CCR) system, as well as EPLS. Future phases of SAM will add the capabilities of other systems used in federal awards processes.

SAM information must be updated at least every 12 months to remain active (for both grantees and sub-recipients). Once you update your record in SAM, it will take 48 to 72 hours to complete the validation processes. will reject electronic submissions from applicants with expired registrations. To Create a user account, Register/Update entity and/or Search Records from CCR, go to .

You will find a Quick Start Guide for Entities Interested in Being Eligible for Grants through SAM at .

3. Registration (get username and password):

Be sure the person submitting your application is properly registered with as the Authorized Organization Representative (AOR) for the specific DUNS number cited on the SF-424 (face page). See the Organization Registration User Guide for details at the following link: .

You can find additional information about the process at .

To submit your application electronically, you may search for the downloadable application package by the funding announcement number (called the opportunity number) or by the Catalogue of Federal Domestic Assistance (CFDA) number. You can find the funding announcement number and CFDA number on the cover page of this funding announcement.

You must follow the instructions in the User Guide available at the apply site, on the Help page. In addition to the User Guide, you may wish to use the following sources for technical (IT) help:

• By e-mail: support@

• By phone: 1-800-518-4726 (1-800-518-GRANTS). The Contact Center is available 24 hours a day, 7 days a week, excluding federal holidays.

Please allow sufficient time to enter your application into . When you submit your application, you will receive a notice that your application is being processed and that you will receive two e-mails from within the next 24-48 hours. One will confirm receipt of the application in , and the other will indicate that the application was either successfully validated by the system (with a tracking number) or rejected due to errors. It will also provide instructions that if you do not receive a receipt confirmation and a validation confirmation or a rejection e-mail within 48 hours, you must contact directly. It is important that you retain this tracking number. Receipt of the tracking number is the only indication that has successfully received and validated your application. If you do not receive a tracking number, you may want to contact the help desk for assistance. Please note that it is incumbent on the applicant to monitor your application to ensure that it is successfully received and validated by . If your application is not successfully validated by , it will not be forwarded to SAMHSA as the receiving institution.

If you experience issues/problems with electronic submission of your application through , contact the helpdesk by email at support@ or by phone at 1-800-518-4726 (1-800-518-GRANTS). Make sure you get a case/ticket/reference number that documents the issues/problems with . It is critical that you initiate electronic submission in sufficient time to resolve any issues/problems that may prevent the electronic submission of your application. will reject applications submitted after 11:59 PM on the application due date.

SAMHSA highly recommends that you submit your application 24-48 hours before the submission deadline. Many submission issues can be fixed within that time and you can attempt to re-submit. However, if you have not completed your , SAM, and DUNS registration at least 2 weeks prior to the submission deadline, it is highly unlikely that these issues will be resolved in time to successfully submit an electronic application.

It is strongly recommended that you prepare your Project Narrative and other attached documents in Adobe PDF format.  If you do not have access to Adobe software, you may submit in Microsoft Office 2007 products (e.g., Microsoft Word 2007, Microsoft Excel 2007, etc.). Directions for creating PDF files can be found on the website.  Use of file formats other than Adobe PDF or Microsoft Office 2007 may result in your file being unreadable by our staff.

The Abstract, Table of Contents, Project Narrative, Supporting Documentation, Budget Justification, and Attachments must be combined into 4 separate files in the electronic submission. If the number of files exceeds 4, only the four files will be downloaded and considered in the peer review of applications. 

Formatting requirements for SAMHSA e-Grant application files are as follows:

• Project Narrative File (PNF): The PNF consists of the Abstract, Table of Contents, and Project Narrative (Sections A-D) in this order and numbered consecutively.

• Budget Narrative File (BNF): The BNF consists of only the budget justification narrative.

• Other Attachment File 1: The first Other Attachment file will consist of the Supporting Documentation (Sections E-F) in this order and lettered consecutively.

• Other Attachment File 2: The second Other Attachment file will consist of the Attachments (Attachments 1-3) in this order and numbered consecutively.

If you have documentation that does not pertain to any of the 4 listed attachment files, include that documentation in Other Attachment File 2.

Other Requirements

Applicants are limited to using the following characters in all attachment file names:

Valid file names may include only the following characters:

• A-Z

• a-z

• 0-9

• Underscore _

• Hyphen –

• Space

• Period .

If your application uses any other characters when naming your attachment files, your application will be rejected by .

Do not use special characters in file names, such as parenthesis ( ), #, ©, etc.

Scanned images must be scanned at 150-200 dpi/ppi resolution and saved as a jpeg or pdf file. Using a higher resolution setting or different file type could result in rejection of your application.

Waiver Request Process

Applicants may request a waiver of the requirement for electronic submission if they are unable to submit electronically through the portal because their physical location does not have adequate access to the Internet. Inadequate Internet access is defined as persistent and unavoidable access problems/issues that would make compliance with the electronic submission requirement a hardship. The process for applying for a waiver is described below. Questions on applying for a waiver may be directed to SAMHSA’s Division of Grant Review, 240-276-1199.

All applicants must register in the System for Award Management (SAM) and , even those who intend to request a waiver. If you do not have an active SAM registration prior to submitting your paper application, it will be screened out and returned to you without review. Registration is necessary to ensure that information required for paper submission is available and that the applicant is ready to submit electronically if the waiver is denied. (See directions for registering in SAM and on above.)

A written waiver request must be received by SAMHSA at least 15 calendar days in advance of the application due date stated on the cover page of this RFA. The request must be either e-mailed to DGR.Waivers@samhsa., or mailed to:

Diane Abbate, Director of Grant Review

Office of Financial Resources

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD 20857

Applicants are encouraged to request a waiver by e-mail, when possible. When requesting a waiver, the following information must be included:

• SAMHSA RFA title and announcement number

• Name, address, and telephone number of the applicant organization as they will appear in the application

• Applicant organization’s DUNS number

• Authorized Organization Representative (AOR) for the named applicant

• Name, telephone number, and e-mail of the applicant organization’s Contact Person for the waiver

• Details of why the organization is unable to submit electronically through the portal, explaining why their physical location does not have adequate access to the Internet.

The Office of Grant Review will either e-mail (if the waiver request was received by e-mail) or express mail/deliver (if the waiver request was received by mail) the waiver decision to the Contact Person no later than seven calendar days prior to the application due date. If the waiver is approved, a paper application must be submitted. (See instructions for submitting a paper application below.) SAMHSA will not accept any applications that are sent by e-mail or facsimile or hand carried. If the waiver is disapproved, the applicant organization must be prepared to submit through or forfeit the opportunity to apply. The written approval must be included as the cover page of the paper application and the application must be received by the due date.

A waiver approval is valid for the remainder of the fiscal year and may be used for other SAMHSA discretionary grant applications during that fiscal year. When submitting a subsequent paper application within the same fiscal year, this waiver approval must be included as the cover page of each paper application. The organization and DUNS number named in the waiver and any subsequent application must be identical.

A paper application will not be accepted without the waiver approval and will be returned to the applicant if it is not included. Paper applications received after the due date will not be accepted.

Instructions for Submitting a Paper Application with a Waiver

Paper submissions are due by 5:00 PM on the application due date stated on the cover page of this RFA. Applications may be shipped using only Federal Express (FedEx), United Parcel Service (UPS), or the United States Postal Service (USPS). You will be notified by postal mail that your application has been received.

Note: If you use the USPS, you must use Express Mail.

SAMHSA will not accept or consider any applications that are sent by e-mail or facsimile or hand carried.

If you are submitting a paper application, you must submit an original application and 2 copies (including attachments). The original and copies must not be bound and nothing should be attached, stapled, folded, or pasted. Do not use staples, paper clips, or fasteners. You may use rubber bands.

Send applications to the address below:

For United States Postal Service:

Diane Abbate, Director of Grant Review

Office of Financial Resources

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD 20857

Change the zip code to 20850 if you are using FedEx or UPS.

Do not send applications to other agency contacts, as this could delay receipt. Be sure to include TI-14-009 in item number 12 on the face page (SF-424) of your paper application. If you require a phone number for delivery, you may use (240) 276-1199.

Your application must be received by the application deadline or it will not be considered for review. Please remember that mail sent to federal facilities undergoes a security screening prior to delivery. You are responsible for ensuring that you submit your application so that it will arrive by the application due date and time.

If an application is mailed to a location or office (including room number) that is not designated for receipt of the application and, as a result, the designated office does not receive your application by the deadline, your application will be considered late and ineligible for review.

If you are submitting a paper application, the application components required for SAMHSA applications should be submitted in the following order:

o Face Page (SF-424)

o Abstract

o Table of Contents

o Budget Information Form (SF-424A)

o Project Narrative and Supporting Documentation

o Attachments

o Project/Performance Site Location(s) Form

o Disclosure of Lobbying Activities (Standard Form LLL, if applicable)

o Checklist – the Checklist should be the last page of your application.

o Documentation of nonprofit status as required in the Checklist

Do not use heavy or lightweight paper or any material that cannot be copied using automatic copying machines. Odd-sized and oversized attachments, such as posters, will not be copied or sent to reviewers. Do not include videotapes, audiotapes, or CD-ROMs.

Black print should be used throughout your application, including charts and graphs (no color). Pages should be typed single-spaced with one column per page. Pages should not have printing on both sides. Pages with printing on both sides run the risk of an incomplete application going to peer reviewers, since scanning and copying may not duplicate the second side.  Materials with printing on both sides will be excluded from the application and not sent to peer reviewers.

With the exception of standard forms in the application package, all pages in your application should be numbered consecutively. Documents containing scanned images must also contain page numbers to continue the sequence. Failure to comply with these requirements may affect the successful transmission and consideration of your application.

Appendix C – Intergovernmental Review (E.O. 12372) Requirements

States with SPOCs

This grant program is covered under Executive Order (EO) 12372, as implemented through Department of Health and Human Services (DHHS) regulation at 45 CFR Part 100. Under this Order, states may design their own processes for reviewing and commenting on proposed federal assistance under covered programs. Certain jurisdictions have elected to participate in the EO process and have established State Single Points of Contact (SPOCs). A current listing of SPOCs is included in the application package and can be downloaded from the Office of Management and Budget (OMB) website at . Check the list to determine whether your state participates in this program. You do not need to do this if you are an American Indian/Alaska Native tribe or tribal organization.

• If your state participates, contact your SPOC as early as possible to alert him/her to the prospective application(s) and to receive any necessary instructions on the state’s review process.

• For proposed projects serving more than one state, you are advised to contact the SPOC of each affiliated state.

• The SPOC should send any state review process recommendations to the following address within 60 days of the application deadline. For United States Postal Service: Diane Abbate, Director of Grant Review, Office of Financial Resources, Substance Abuse and Mental Health Services Administration, Room 3-1044, 1 Choke Cherry Road, Rockville, MD 20857. ATTN: SPOC – Funding Announcement No. TI-14-009. Change the zip code to 20850 if you are using another delivery service.

States without SPOCs

If your state does not have a SPOC and you are a community-based, non-governmental service provider, you must submit a Public Health System Impact Statement (PHSIS)[1] to the head(s) of appropriate state and local health agencies in the area(s) to be affected no later than the application deadline. The PHSIS is intended to keep state and local health officials informed of proposed health services grant applications submitted by community-based, non-governmental organizations within their jurisdictions. If you are a state or local government or American Indian/Alaska Native tribe or tribal organization, you are not subject to these requirements.

The PHSIS consists of the following information:

• a copy of the face page of the application (SF-424); and

• a summary of the project, no longer than one page in length, that provides: 1) a description of the population to be served; 2) a summary of the services to be provided; and 3) a description of the coordination planned with appropriate state or local health agencies.

For SAMHSA grants, the appropriate state agencies are the Single State Agencies (SSAs) for substance abuse and mental health. A listing of the SSAs for substance abuse can be found on SAMHSA’s website at . A listing of the SSAs for mental health can be found on SAMHSA’s website at . If the proposed project falls within the jurisdiction of more than one state, you should notify all representative SSAs.

If applicable, you must include a copy of a letter transmitting the PHSIS to the SSA in Attachment 4, “Letter to the SSA.” The letter must notify the state that, if it wishes to comment on the proposal, its comments should be sent no later than 60 days after the application deadline to the following address. For United States Postal Service: Diane Abbate, Director of Grant Review, Office of Financial Resources, Substance Abuse and Mental Health Services Administration, Room 3-1044, 1 Choke Cherry Road, Rockville, MD 20857. ATTN: SSA – Funding Announcement No. “PCSS-Opioids and TI-14-009.” Change the zip code to 20850 if you are using another delivery service.

In addition:

• Applicants may request that the SSA send them a copy of any state comments.

• The applicant must notify the SSA within 30 days of receipt of an award.

Appendix D – Funding Restrictions

SAMHSA grant funds must be used for purposes supported by the program and may not be used to:

• Pay for any lease beyond the project period.

• Provide services to incarcerated populations (defined as those persons in jail, prison, detention facilities, or in custody where they are not free to move about in the community).

• Pay for the purchase or construction of any building or structure to house any part of the program. (Applicants may request up to $75,000 for renovations and alterations of existing facilities, if necessary and appropriate to the project.)

• Provide residential or outpatient treatment services when the facility has not yet been acquired, sited, approved, and met all requirements for human habitation and services provision. (Expansion or enhancement of existing residential services is permissible.)

• Pay for housing other than residential mental health and/or substance abuse treatment.

• Provide inpatient treatment or hospital-based detoxification services. Residential services are not considered to be inpatient or hospital-based services.

• Only allowable costs associated with the use of federal funds are permitted to fund evidence-based practices (EBPs). Other sources of funds may be used for unallowable costs (e.g., meals, sporting events, entertainment). Other support is defined as funds or resources, whether federal, non-federal or institutional, in direct support of activities through fellowships, gifts, prizes, or in-kind contributions.

• Make direct payments to individuals to induce them to enter prevention or treatment services. However, SAMHSA discretionary grant funds may be used for non-clinical support services (e.g., bus tokens, child care) designed to improve access to and retention in prevention and treatment programs.

• Make direct payments to individuals to encourage attendance and/or attainment of prevention or treatment goals. However, SAMHSA discretionary grant funds may be used for non-cash incentives of up to $30 to encourage attendance and/or attainment of prevention or treatment goals when the incentives are built into the program design and when the incentives are the minimum amount that is deemed necessary to meet program goals. SAMHSA policy allows an individual participant to receive more than one incentive over the course of the program. However, non-cash incentives should be limited to the minimum number of times deemed necessary to achieve program outcomes. A grantee or treatment or prevention provider may also provide up to $30 cash or equivalent (coupons, bus tokens, gifts, child care, and vouchers) to individuals as incentives to participate in required data collection follow up. This amount may be paid for participation in each required interview.

• Meals are generally unallowable unless they are an integral part of a conference grant or specifically stated as an allowable expense in the RFA. Grant funds may be used for light snacks, not to exceed $2.50 per person.

• Funds may not be used to distribute sterile needles or syringes for the hypodermic injection of any illegal drug.

• Pay for pharmacologies for HIV antiretroviral therapy, sexually transmitted diseases (STD)/sexually transmitted illnesses (STI), TB, and hepatitis B and C, or for psychotropic drugs.

SAMHSA will not accept a “research” indirect cost rate. The grantee must use the “other sponsored program rate” or the lowest rate available.

Appendix E – Biographical Sketches and Job Descriptions

Biographical Sketch

Existing curricula vitae of project staff members may be used if they are updated and contain all items of information requested below. You may add any information items listed below to complete existing documents. For development of new curricula vitae include items below in the most suitable format:

1. Name of staff member

2. Educational background: school(s), location, dates attended, degrees earned (specify year), major field of study

3. Professional experience

4. Honors received and dates

5. Recent relevant publications

6. Other sources of support [Other support is defined as all funds or resources, whether federal, non-federal, or institutional, available to the Project Director/Program Director (and other key personnel named in the application) in direct support of their activities through grants, cooperative agreements, contracts, fellowships, gifts, prizes, and other means.]

Job Description

1. Title of position

2. Description of duties and responsibilities

3. Qualifications for position

4. Supervisory relationships

5. Skills and knowledge required

6. Personal qualities

7. Amount of travel and any other special conditions or requirements

8. Salary range

9. Hours per day or week

Appendix F – Sample Budget and Justification (no match required)

THIS IS AN ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND NARRATIVE JUSTIFICATION WITH GUIDANCE FOR COMPLETING SF-424A: SECTION B FOR THE BUDGET PERIOD

A. Personnel: Provide employee(s) (including names for each identified position) of the applicant/recipient organization, including in-kind costs for those positions whose work is tied to the grant project.

FEDERAL REQUEST

|Position |Name |Annual Salary/Rate |Level of Effort |Cost |

|(1) Project Director |John Doe |$64,890 |10% |$6,489 |

|(2) Grant Coordinator |To be selected |$46,276 |100% |$46,276 |

|(3) Clinical Director |Jane Doe |In-kind cost |20% |0 |

| | | |TOTAL |$52,765 |

JUSTIFICATION: Describe the role and responsibilities of each position.

1) The Project Director will provide daily oversight of the grant and will be considered key staff.

2) The Coordinator will coordinate project services and project activities, including training, communication and information dissemination.

3) The Clinical Director will provide necessary medical direction and guidance to staff for 540 clients served under this project.

Key staff positions require prior approval by SAMHSA after review of credentials of resume and job description.

FEDERAL REQUEST (enter in Section B column 1 line 6a of form S-424A) $52,765

B. Fringe Benefits: List all components that make up the fringe benefits rate

FEDERAL REQUEST

|Component |Rate |Wage |Cost |

|FICA |7.65% |$52,765 | $4,037 |

|Workers Compensation |2.5% |$52,765 | $1,319 |

|Insurance |10.5% |$52,765 | $5,540 |

| | |TOTAL | $10,896 |

JUSTIFICATION: Fringe reflects current rate for agency.

FEDERAL REQUEST (enter in Section B column 1 line 6b of form SF-424A) $10,896

C. Travel: Explain need for all travel other than that required by this application. Local travel policies prevail.

FEDERAL REQUEST

|Purpose of Travel |Location |Item |Rate |Cost |

|(1) Grantee Conference |Washington, DC |Airfare |$200/flight x 2 persons |$400 |

| | |Hotel |$180/night x 2 persons x 2 nights |$720 |

| | |Per Diem (meals and |$46/day x 2 persons x 2 days |$184 |

| | |incidentals) | | |

|(2) Local travel | |Mileage |3,000 miles@.38/mile |$1,140 |

| | | |TOTAL |$2,444 |

JUSTIFICATION: Describe the purpose of travel and how costs were determined.

(1) Two staff (Project Director and Evaluator) to attend mandatory grantee meeting in Washington, DC.

(2) Local travel is needed to attend local meetings, project activities, and training events. Local travel rate is based on organization’s policies/procedures for privately owned vehicle reimbursement rate. If policy does not have a rate use GSA.

FEDERAL REQUEST (enter in Section B column 1 line 6c of form SF-424A) $2,444

D. Equipment: An article of tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit (federal definition).

FEDERAL REQUEST – (enter in Section B column 1 line 6d of form SF-424A) $ 0

E. Supplies: Materials costing less than $5,000 per unit and often having one-time use

FEDERAL REQUEST

|Item(s) |Rate |Cost |

|General office supplies |$50/mo. x 12 mo. |$600 |

|Postage |$37/mo. x 8 mo. |$296 |

|Laptop Computer |$900 |$900 |

|Printer |$300 |$300 |

|Projector |$900 |$900 |

|Copies |8000 copies x .10/copy |$800 |

| |TOTAL |$3,796 |

JUSTIFICATION: Describe the need and include an adequate justification of how each cost was estimated.

(1) Office supplies, copies and postage are needed for general operation of the project.

(2) The laptop computer and printer are needed for both project work and presentations for Project Director.

(3) The projector is needed for presentations and workshops. All costs were based on retail values at the time the application was written.

FEDERAL REQUEST – (enter in Section B column 1 line 6e of form SF-424A) $ 3,796

F. Contract: A contractual arrangement to carry out a portion of the programmatic effort or for the acquisition of routine goods or services under the grant. Such arrangements may be in the form of consortium agreements or contracts. A consultant is an individual retained to provide professional advice or services for a fee. The applicant/grantee must establish written procurement policies and procedures that are consistently applied. All procurement transactions shall be conducted in a manner to provide to the maximum extent practical, open and free competition.

COSTS FOR CONTRACTS MUST BE BROKEN DOWN IN DETAIL AND A NARRATIVE JUSTIFICATION PROVIDED. IF APPLICABLE, NUMBERS OF CLIENTS SHOULD BE INCLUDED IN THE COSTS.

FEDERAL REQUEST

|Name |Service |Rate |Other |Cost |

|(1) State Department of |Training |$250/individual x 3 staff |5 days |$750 |

|Human Services | | | | |

| |1040 Clients |$27/client per year | |$28,080 |

|(2) Treatment Services | | | | |

|(3) John Smith (Case |Treatment Client | |*Travel at 3,124 @ .50 per |$46,167 |

|Manager) |Services | |mile = $1,562 | |

| | |1FTE @ $27,000 + Fringe |*Training course $175 | |

| | |Benefits of $6,750 = $33,750 |*Supplies @ $47.54 x 12 | |

| | | |months or $570 | |

| | | |*Telephone @ $60 x 12 months | |

| | | |= $720 | |

| | | |*Indirect costs = $9,390 | |

| | | |(negotiated with contractor) | |

| |Evaluator |$40 per hour x 225 hours |12 month period |$9,000 |

|(4) Jane Smith | | | | |

|(5) To Be Announced |Marketing Coordinator |Annual salary of $30,000 x 10% | |$3,000 |

| | |level of effort | | |

| | | |TOTAL |$86,997 |

JUSTIFICATION: Explain the need for each contractual agreement and how it relates to the overall project.

1) Certified trainers are necessary to carry out the purpose of the statewide Consumer Network by providing recovery and wellness training, preparing consumer leaders statewide, and educating the public on mental health recovery.

2) Treatment services for clients to be served based on organizational history of expenses.

3) Case manager is vital to client services related to the program and outcomes.

4) Evaluator is provided by an experienced individual (Ph.D. level) with expertise in substance abuse, research and evaluation, is knowledgeable about the population of focus, and will report GPRA data.

5) Marketing Coordinator will develop a plan to include public education and outreach efforts to engage clients of the community about grantee activities, and provision of presentations at public meetings and community events to stakeholders, community civic organizations, churches, agencies, family groups and schools.

*Represents separate/distinct requested funds by cost category

FEDERAL REQUEST – (enter in Section B column 1 line 6f of form SF-424A) $86,997

G. Construction: NOT ALLOWED – Leave Section B columns 1& 2 line 6g on SF-424A blank.

H. Other: Expenses not covered in any of the previous budget categories

FEDERAL REQUEST

|Item |Rate |Cost |

|(1) Rent* |$15/sq.ft x 700 sq. feet |$10,500 |

|(2) Telephone |$100/mo. x 12 mo. |$1,200 |

|(3) Client Incentives |$10/client follow up x 278 clients |$2,780 |

|(4) Brochures |.89/brochure X 1500 brochures |$1,335 |

| |TOTAL |$15,815 |

JUSTIFICATION: Break down costs into cost/unit (e.g. cost/square foot). Explain the use of each item requested.

(1) Office space is included in the indirect cost rate agreement; however, if other rental costs for service site(s) are necessary for the project, they may be requested as a direct charge. The rent is calculated by square footage or FTE and reflects SAMHSA’s fair share of the space.

*If rent is requested (direct or indirect), provide the name of the owner(s) of the space/facility. If anyone related to the project owns the building which is less than an arms length arrangement, provide cost of ownership/use allowance calculations. Additionally, the lease and floor plan (including common areas) is required for all projects allocating rent costs.

(2) The monthly telephone costs reflect the percent of effort for the personnel listed in this application for the SAMHSA project only.

(3) The $10 incentive is provided to encourage attendance to meet program goals for 278 client follow-ups.

(4) Brochures will be used at various community functions (health fairs and exhibits).

FEDERAL REQUEST – (enter in Section B column 1 line 6h of form SF-424A) $15,815

Indirect Cost Rate: Indirect costs can be claimed if your organization has a negotiated indirect cost rate agreement. It is applied only to direct costs to the agency as allowed in the agreement. For information on applying for the indirect rate go to: .

FEDERAL REQUEST (enter in Section B column 1 line 6j of form SF-424A)

8% of personnel and fringe (.08 x $63,661) $5,093

==================================================================

TOTAL DIRECT CHARGES:

FEDERAL REQUEST – (enter in Section B column 1 line 6i of form SF-424A) $172,713

INDIRECT CHARGES:

FEDERAL REQUEST – (enter in Section B column 1 line 6j of form SF-424A) $5,093

TOTAL: (sum of 6i and 6j)

FEDERAL REQUEST – (enter in Section B column 1 line 6k of form SF-424A) $177,806

==================================================================

Provide the total proposed project period and federal funding as follows:

Proposed Project Period

|a. Start Date: |09/30/2012 | b. End Date: |09/29/2017 |

BUDGET SUMMARY (should include future years and projected total)

|Category |Year 1 |Year 2* |Year 3* |Year 4* |Year 5* |

|Direct Services: Number to be served |200 |175 |100 |125 |600 |

|By Race/Ethnicity |  |  |  |  |  |

|African American |10 |9 |5 |6 |30 |

|American Indian/Alaska Native |1 |1 |0 |1 |3 |

|Asian |2 |2 |1 |1 |6 |

|White (non-Hispanic) |103 |91 |52 |65 |311 |

|Hispanic or Latino (not including Salvadoran) |32 |28 |16 |20 |96 |

| Salvadoran |44 |37 |22 |28 |130 |

|Native Hawaiian/Other Pacific Islander |4 |3 |2 |2 |11 |

|Two or more Races |4 |4 |2 |3 |13 |

|By Gender |  |  |  |  |  |

|Female |110 |96 |55 |69 |330 |

|Male |89 |79 |44 |56 |268 |

|Transgender |1 |0 |1 |0 |2 |

|By Sexual Orientation/Identity Status |  |  |  |  |  |

|Lesbian |2 |2 |1 |1 |6 |

|Gay |8 |6 |4 |5 |23 |

|Bisexual |1 |1 |0 |1 |3 |

The population of Middle Lake, Massachusetts is predominantly represented by first- and second-generation Latinos, mainly from El Salvador. There has been a recent increase of the immigrant population in the city with individuals primarily from Haiti and El Salvador. There is also a smaller Cambodian and African American population in the city. Nearly 40% of residents speak a language other than English in their homes, and a majority of those individuals are Spanish speakers. There is a high unemployment rate, low literacy rate and high level of poverty, in particular among the Salvadoran subpopulation, putting these individuals at greater risk for behavioral health issues when compared to national trends. However, our agency does not have sufficient capacity to address the cultural and linguistic needs of the Salvadorans in the community. Therefore, we have chosen to focus our efforts on increasing staff and organizational competencies to address the disparities in behavioral health awareness and education within the Salvadoran population.

2. A Quality Improvement Plan Using Our Data

A continuous quality improvement approach will be used to analyze, assess and monitor key performance indicators as a mechanism to ensure high-quality and effective program operations. Monitoring activities will focus on:

Access: The project team will collaborate with the community enrichment program and the county health specialist consortium in planning the design and implementation of program activities to ensure the cultural and linguistic needs of training recipients are effectively addressed, particularly the disparate population.

Use: Training and technical assistance activities will be designed and implemented in accordance with the cultural and linguistic needs of individuals in the community.

Outcomes: Program data will be used to monitor and manage program outcomes by race, ethnicity, and LGBT status within a quality improvement process. Programmatic adjustments will be made as indicated to address identified issues, including behavioral health disparities, across program domains.

A primary objective of the data collection and reporting will be to monitor/measure project activities in a manner that optimizes the usefulness of data for project staff and consumers; evaluation findings will be integrated into program planning and management on an ongoing basis (a “self-correcting” model of evaluation). For example, training and technical assistance data will be reported to staff on an ongoing basis, including analyses and discussions of who may be more or less likely to be exposed to training and technical assistance activities. The Evaluator will meet on a bi-weekly basis with staff, providing an opportunity for staff to identify successes and barriers encountered in the process of project implementation. These meetings will be a forum for discussion of evaluation findings, allowing staff to adjust or modify project services to maximize project success.

Outcomes for all activities will be monitored across race and ethnicity to determine the grant’s impact on behavioral health disparities.

3. Adherence to the CLAS Standards

Our quality improvement plan will ensure adherence to the enhanced National Standards for Culturally and Linguistically Appropriate Services (CLAS Standards) in Health and Health Care. This will include attention to:

a. Diverse cultural health beliefs and practices

Training and hiring protocols will be implemented to support the culture and language of all subpopulations, with a focus on the Salvadoran subpopulation.

b. Preferred languages

Interpreters and translated materials will be used for non-English speaking participants as well as those who speak English, but prefer materials in their primary language. Key documents will be translated into Spanish.

c. Health literacy and other communication needs of all sub-populations identified in your proposal

All training and technical assistance activities will be tailored to include limited English proficient individuals. Staff will receive training to ensure capacity to provide services that are culturally and linguistically appropriate.

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[1] Approved by OMB under control no. 0920-0428; Public reporting burden for the Public Health System Reporting Requirement is estimated to average 10 minutes per response, including the time for copying the face page of SF-424 and the abstract and preparing the letter for mailing. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0920-0428. Send comments regarding this burden to CDC Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428).

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